Individual
CHARLES DAVIS MARTIN
Active
Individual
CHARLES DAVIS MARTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
FNP-C
Taxonomy
Speciality
Code
Description
License number
State
2085R0204X
Vascular & Interventional Radiology Physician
RN250185
GA
363LF0000X
Family Nurse Practitioner
Primary
RN250185
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
W274616956
AETNA
—
Enumeration date
11/01/2022
Last updated
07/05/2023
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